Provider Demographics
NPI:1316081243
Name:JENNINGS, SALLYANN (MS RN CS P)
Entity type:Individual
Prefix:MS
First Name:SALLYANN
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MS RN CS P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 LANASA LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4143
Mailing Address - Country:US
Mailing Address - Phone:410-682-6269
Mailing Address - Fax:410-576-1268
Practice Address - Street 1:22 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3951
Practice Address - Country:US
Practice Address - Phone:410-682-6269
Practice Address - Fax:410-576-1268
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR052595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health